Frequency and significance of right ventricular dysfunction during inferior wall left ventricular myocardial infarction treated with thrombolytic therapy (results from the Thrombolysis in Myocardial Infarction [TIMI] II trial)

Berger, Peter B.; Ruocco, Nicholas A.; Ryan, Thomas J.; Jacobs, Alice K.; Zaret, Barry L.; Wackers, Frans J. Th.; Frederick, Margaret; Faxon, David P.

doi:10.1016/0002-9149(93)90637-r

Cited by 108 publications

(45 citation statements)

References 20 publications

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“…Fibrinolytic therapy reduces the incidence of RV dysfunction. 252 Similarly PCI is an alternative for patients with RV infarction and is preferred for patients in shock. Patients with shock caused by RV failure have a mortality rate similar to that for patients with shock due to LV failure.…”

Section: Rv Infarctionmentioning

confidence: 99%

Part 10: Acute Coronary Syndromes

O’Connor¹,

Brady²,

Brooks³

et al. 2010

Circulation

238

167

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Section: Rv Infarctionmentioning

confidence: 99%

Part 10: Acute Coronary Syndromes

O’Connor¹,

Brady²,

Brooks³

et al. 2010

Circulation

238

167

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“…22 However, although the number of patients with RV infarction is small, these patients seem to have a higher risk of in-hospital mortality in the mechanical reperfusion era than during the fibrinolytic era. Figure 2 shows the changes in the in-hospital mortality rate and relative risk of RV infarction for in-hospital mortality between the fibrinolytic and mechanical reperfusion era; 8,[23][24][25][26][27][28][29][30][31][32][33][34][35][36] An increase in the relative risk of RV infarction from 2.29 (95% CI 1.67-3.14) to 2.98 (95% CI 1.41-6.31) also occurred during this period. The precise explanation for the paradox remains unknown.…”

Section: Short-term Prognosismentioning

confidence: 99%

“…These data were derived from previously published meta-analyses, 21 which included many prospective or retrospective studies, assessing the impact of RV infarction in patients with acute MI up to June 2007, 8,[23][24][25][26][27][28][29][30][33][34][35][36] and two additional observational studies that met the same inclusion criteria up to June 2012. 31,32 of concomitant LV involvement, this study indicated that the mean optimal PWP, which corresponded to the maximum LV stroke work index in each patient, was 16 mmHg.…”

Section: Volume Replacementmentioning

confidence: 99%

The challenges in the management of right ventricular infarction

Inohara

Kohsaka

Fukuda

et al. 2013

European Heart Journal: Acute Cardiovascular Care

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In recent years, right ventricular (RV) infarction seems to be underdiagnosed in most cases of acute myocardial ischaemia despite its frequent association with inferior-wall and, occasionally, anterior-wall myocardial infarction (MI). However, its initial management is drastically different from that of left ventricular MI, and studies have indicated that RV infarction remains associated with significant morbidity and mortality, even in the mechanical reperfusion era. The pathophysiology of RV infarction involves the interaction between the right and left ventricle (LV), and the mechanism has been clarified with the advent of diagnostic non-invasive modalities, such as echocardiography and cardiac magnetic resonance. In recent years, considerable progress has been made in the treatment of RV infarction; early revascularization remains the cornerstone of the management, and fluid resuscitation, with appropriate target selection, is necessary to maintain appropriate preload. Early recognition in intensive care with clear understanding of the pathophysiology is essential to improve its prognosis. In terms of management, the support strategy for RV dysfunction is different from that for LV dysfunction since the former may often be temporary. Along with early reperfusion, maintenance of an adequate heart rate and atrioventricular synchrony are essential to sustain a sufficient cardiac output in patients with RV infarction. In refractory cases, more intensive mechanical support is required, and new therapeutic options, such as Tandem-Heart or percutaneous cardiopulmonary support systems, are being developed.

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“…4 Right ventricular myocardial infarction and atrioventricular blocks are seen in 10-15 % patients with inferior MI due to RCA occlusion. 1,5,6 "The management, and in some instances, prevention of these complications, may be facilitated by early differentiation between AMI caused by RCA versus left circumflex coronary artery occlusion. 7 These can be diagnosed from the electrocardiography (ECG) which remains a valuable and most widely used rational modality to diagnose and risk stratifying in an acute setting.…”

Section: Introductionmentioning

confidence: 99%

Study of electrocardiographic differentiation between RCA and LCx occlusion in isolated inferior wall myocardial infarction

Pendse

Dave

et al. 2016

Int J Res Med Sci

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INTRODUCTIONInferior myocardial infarctions account for 40 to 50 % of all acute myocardial infarctions and are generally viewed as having a more favourable prognosis than anterior wall infarctions.1-3 Nearly 50% of patients suffering from inferior wall myocardial infarction, usually experience hemodynamic and bradycardiac complications.1 Anterior wall myocardial infarction invariably occurred by occlusion of the left anterior descending coronary artery.However inferior wall myocardial infarction can result from occlusion of either the right coronary artery or left circumflex coronary artery. 4 Right ventricular myocardial ABSTRACTBackground: Inferior myocardial infarctions account for 40 to 50% of all acute myocardial infarctions and are generally viewed as having a more favorable prognosis than anterior wall infarctions. The management, and in some instances, prevention of these complications, may be facilitated by early differentiation between AMI caused by RCA versus left circumflex coronary artery occlusion. These can be diagnosed from the electrocardiography (ECG) which remains a valuable and most widely used rational modality to diagnose and risk stratifying in an acute setting. The present study helps in Electrocardiographic differentiation between right coronary and the left circumflex coronary arterial occlusion in isolated inferior wall myocardial infarction. Results:Out of 52 patients of acute inferior wall myocardial infraction, 41 were males and 11 were females. Thus the male to female ratio is 3.72:1. In the above table, the ST segment elevation in lead III was more than lead ii in42 patients. All these 42 patients were found to have RCA as the culprit vessel. The St Segment elevation in lead II was more than lead III in 9 patients. All these 9 patients were found to have LCx as the culprit vessel. Conclusions:The incidence of acute inferior wall myocardial infarction is highest in age group of 50 to 59 years. The ST segment elevation in acute isolated inferior wall myocardial infarction was greater in lead III than in lead II when right coronary artery was the culprit vessel and vice versa when the left circumflex coronary artery was the culprit vessel. ST segment depression in lead I was common when the right coronary artery was the culprit vessel and not seen with left circumflex coronary artery occlusion. An upright T wave in lead V4R in acute isolated inferior wall myocardial infarction was common when the right coronary artery was the culprit vessel and not seen with left circumflex coronary artery occlusion.

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Frequency and significance of right ventricular dysfunction during inferior wall left ventricular myocardial infarction treated with thrombolytic therapy (results from the Thrombolysis in Myocardial Infarction [TIMI] II trial)

Cited by 108 publications

References 20 publications

Part 10: Acute Coronary Syndromes

Part 10: Acute Coronary Syndromes

The challenges in the management of right ventricular infarction

Study of electrocardiographic differentiation between RCA and LCx occlusion in isolated inferior wall myocardial infarction

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